Accuracy of Pallor in the Diagnosis of Anemia in Children Aged 6 Months to 5 Years

Abstract

Background: The diagnosis and management of anemia largely depends on clinical assessment for pallor. Pallor is explained as decreased colour of the skin and mucous membranes. Aims and Objectives: To study sensitivity, specificity and predictive value of pallor at palpebral conjunctiva, tongue, nail bed and palm in diagnosing anemia and correlate pallor with hemoglobin. Subjects and Methods: 400 children aged between 6 months to 5 years out of which 200 having pallor (Cases) and 200 no pallor (Controls), admitted at Department of Pediatrics, D.Y.Patil Medical college and hospital, Kolhapur from 1st October 2016 to 31st March 2018 were included in this study. Palpebral conjunctiva, tongue, nailbed and palms were examined for pallor. Hemoglobin estimation were done by Drabkin’s method in all children. Anemia was defined according to WHO criteria (Hb < 11g/dl). Data was analyzed statistically. Results: Among 200 children with pallor, tongue pallor was identified in maximum (79%), palmar pallor in minimum (61%). Mean hemoglobin in pallor group ranged from 8.7 to 9.04g/dl and 10.96 to 11.1g/dl in no pallor group. Hemoglobin was lowest with tongue pallor (8.7g/dl). Children with pallor group, 160(71%) had anemia and no pallor group 140 (77%) had no anemia. Maximum sensitivity and specificity were for tongue pallor (59.5%) and palmar pallor (92.2%) respectively and maximum predictive value was for palmar pallor (88.2%). Conclusion: Pallor was found to be very useful in detecting anemia, also it had more specific than sensitive value. The best predictor site for pallor for diagnosing anemia was palm.